An update on spinal cord injury and diaphragm neuromotor control.

introductionUnderstanding neuromotor control of the diaphragm muscle (DIAm) is the foundation for developing therapeutic approaches for functional recovery of ventilatory and non-ventilatory behaviors. Although the DIAm is the primary inspiratory pump, it plays a vital role in a wide variety of higher-force behaviors including airway clearance activities. After spinal cord injury (SCI), higher-force behaviors experience the greatest deficits. A classification scheme for SCI that incorporates this information would be clinically valuable. AREAS COVERED: We begin by presenting foundational information about DIAm motor units. In addition, we introduce a classification scheme of SCI based on the impact it has on neural circuitry involved in breathing and other functions of the DIAm. Finally, we consider various promising therapeutic options available to improve DIAm motor function. Relevant literature was identified by searching PubMed and Google Scholar without specific limits on the dates. EXPERT OPINION: Classification of SCI based on its impact on the neural circuitry involved in DIAm motor behaviors is an important part of developing effective therapeutics. An approach that considers the specific type of SCI and leverages a combination of interventions will likely yield the best outcomes for restoring both ventilatory and non-ventilatory functions.